Levels Of Symptom Severity Research Articles

Anxiety sensitivity and experiential avoidance: Relations with anxiety severity and treatment outcomes in anxious youth.

Anxiety sensitivity (AS) and experiential avoidance (EA) are associated with anxiety in both adults and youths. This study examined the separate contributions of AS and EA in predicting (a) anxiety (symptom severity) and (b) differential treatment outcomes in anxious youth receiving cognitive behavioral therapy (CBT). Participants (N = 89; age 10-17 years; 37% male; 78% white) met diagnostic criteria for an anxiety disorder and received CBT (Coping Cat). AS and EA were child-report measures collected at baseline. The outcome variables were anxiety symptom severity (Multidimensional Anxiety Scale for Children; child- and parent-reported) and Independent Evaluator-rated anxiety severity (Child Global Impression-Severity) collected at baseline and posttreatment. Multilevel models (MLM) examined independent and relative contributions of AS and EA to the outcome variables as a secondary analysis. Both AS and EA were associated with levels of anxiety symptom severity at pretreatment and at posttreatment, varying by reporter. Neither AS nor EA predicted differential treatment outcomes: youth at varying levels had comparably favorable outcomes. Findings suggest similarity in AS and EA, and that both constructs may be adequately and equally addressed in CBT. Future research could consider examining change in AS and EA and anxiety across treatment in diverse populations.

Effect of Unified Protocol on neuroticism, emotion regulation skills, and symptom severity—A case series

BackgroundThere has been a shift from single disease protocols to interventions that address shared vulnerabilities across disorders with high comorbidity. Unified Protocol (UP) is an emotion-focused transdiagnostic intervention that addresses neuroticism, a shared mechanism identified in emotional disorders by enhancing emotion regulation skills. In this study, we attempted to understand the effect of the (UP) on symptom severity, emotion regulation, and neuroticism. MethodsA non-concurrent multiple baseline design was adopted. Six clients with a primary diagnosis of an anxiety disorder were randomly assigned to a 2, 3, or 4-week baseline period, following medication stabilization for 4 weeks. Following the baseline period, UP was delivered over 15–18 sessions. Neuroticism and emotion regulation were assessed at baseline, post, and follow-up. Anxiety severity was measured weekly by both an independent rater and on self-report. ResultsOf the 6 clients randomized, 3 completed the intervention. Visual analysis was used to examine changes in symptom severity and Reliable Change Index (RCI) was used to examine changes in scores on neuroticism and emotion regulation across time points for the 3 completers. Reliable change was observed in 1 out of 3 clients for neuroticism and in 2 out of 3 clients for emotion regulation skills. Change in slope, and level of symptom severity was observed across participants. ConclusionsUP is a parsimonious approach to addressing co-morbidities. Our findings support the role of emotion regulation skills in the management of anxiety. A larger sample is required to establish these findings more robustly and support generalization of findings.

Understanding mHealth Patient-Reported Priority Symptoms for Gynecologic Cancer During Chemotherapy: A Secondary Analysis.

To determine the percentage of and the most prevalent moderate to severe symptoms and to analyze longitudinal patterns and co-occurrence of symptoms during the first three cycles of chemotherapy. A secondary analysis of 26 women with gynecologic cancer who reported daily symptoms. Moderate to severe symptom presence and severity levels were calculated as proportions. Symptoms for each patient were graphed during three cycles and analyzed for patterns of onset, duration, and clustering. Patients completed 1,562 calls to the remote symptom monitoring system. The most commonly reported moderate to severe symptoms were pain, fatigue, and trouble sleeping. Pain and fatigue co-occurred with trouble sleeping in one symptom pattern. Patterns included no moderate to severe symptoms, moderate to severe symptoms during one cycle, moderate to severe symptoms during two cycles, and moderate to severe symptoms during all cycles. Nurses should consistently assess symptoms across cycles. To verify distinct classes of symptoms and better target interventions, further study is warranted.

Depression and thoughts of self-harm and suicide among people living with dementia: results of a cross-sectional survey.

Depression is common among people with dementia. Despite most people with dementia living in the community, there have been few investigations of self-reported depressive symptoms and suicidal ideation among community-dwelling people with dementia in Australia. This study aimed to explore the proportion of people with mild, moderate and severe levels of depressive symptoms, and suicidal ideation among a sample of people living with dementia in Australia. Correlates of reporting depressive symptoms were also explored. Adults diagnosed with dementia by a medical professional who were English speaking and community-dwelling were asked to complete a paper and pencil survey. Those who were unable to provide independent consent were excluded. Depression was assessed using the Geriatric Depression Scale -15, and suicidal ideation was assessed using two study-specific items. Multivariable analyses examined quality of life, unmet needs and sociodemographic factors associated with having a score of five or more on the Geriatric Depression Scale-15. Ninety-four people participated in the study. Thirty-seven percent (n = 35) reported some level of depressive symptoms, with most of these (21%, n = 20) classified as having mild depressive symptoms. Five participants (5%) reported they had had thoughts of being better off dead or hurting themselves, while three (3%) reported having had a plan to end their life. For each additional unmet need, the odds of being depressed increased by 25%(P < 0.001). For each point increase in quality of life, the odds of being depressed decreased by 48% (P < 0.001). The high proportion of people with dementia who report depressive symptoms suggests the need to routinely assess depressive symptoms among this group. There may also be benefits in assessing unmet needs and addressing these where possible as part of an approach to reducing depression among people living with dementia in the community.

Associations of Nonmotor Symptom Burden, Activities of Daily Living, and Fear of Falling in Parkinson Disease.

BACKGROUND: Parkinson disease (PD), a neurodegenerative disease characterized by motor and nonmotor symptoms, can affect the daily activities of individuals. This study was conducted to determine nonmotor symptom burden in patients with PD and to reveal the relationship of nonmotor symptom burden with activities of daily living and fear of falling. METHODS: This cross-sectional and correlational study was carried out with 309 patients given a diagnosis of PD. The data were collected using a personal information form, the Non-Motor Symptoms Scale, the Katz Activities of Daily Living Scale, and the Fear of Falling Questionnaire. RESULTS: Whereas 70.2% of the patients had very high nonmotor symptom severity levels, 33.7% were semidependent or dependent in terms of performing their activities of daily living. The fear of falling was experienced by 32.7% of the patients. A statistically significant inverse relationship was found between the mean Non-Motor Symptoms Scale scores of the patients and their mean Katz Activities of Daily Living Scale and Fear of Falling Questionnaire scores (P < .05). Nonmotor symptom burden independently explained 66% of the total variance in the performance of activities of daily living and 69% of the total variance in fear of falling (P < .01). CONCLUSION: Nonmotor symptom burden in PD patients is a significant determinant for participation in activities of daily living and fear of falling. Nurses should approach patients with PD with a focus not only on assessing motor symptoms but also on assessing nonmotor symptoms.

The role of symptoms severity, heart rate, and central sensitization for predicting sleep quality in patients with fibromyalgia.

Clinical predictors of sleep quality in patients with fibromyalgia syndrome (FMS) are still unknown. By identifying these factors, we could raise new mechanistic hypotheses and guide management approaches. We aimed to describe the sleep quality of FMS patients and to explore the clinical and quantitative sensory testing (QST) predictors of poor sleep quality and its subcomponents. This study is a cross-sectional analysis of an ongoing clinical trial. We performed linear regression models between sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and demographic, clinical, and QST variables, controlling for age and gender. Predictors for the total PSQI score and its seven subcomponents were found using a sequential modeling approach. We included 65 patients. The PSQI score was 12.78 ± 4.39, with 95.39% classified as poor sleepers. Sleep disturbance, use of sleep medications, and subjective sleep quality were the worst subdomains. We found poor PSQI scores were highly associated with symptom severity (FIQR score and PROMIS fatigue), pain severity, and higher depression levels, explaining up to 31% of the variance. Fatigue and depression scores also predicted the subjective sleep quality and daytime dysfunction subcomponents. Heart rate changes (surrogate of physical conditioning) predicted the sleep disturbance subcomponent. QST variables were not associated with sleep quality or its subcomponents. Symptom severity, fatigue, pain, and depression (but no central sensitization) are the main predictors of poor sleep quality. Heart rate changes independently predicted the sleep disturbance subdomain (the most affected one in our sample), suggesting an essential role of physical conditioning in modulating sleep quality in FMS patients. This underscores the need for multidimensional treatments targeting depression and physical activity to improve the sleep quality of FMS patients.

Development and Validation of a Joint Attention–Based Deep Learning System for Detection and Symptom Severity Assessment of Autism Spectrum Disorder

Joint attention, composed of complex behaviors, is an early-emerging social function that is deficient in children with autism spectrum disorder (ASD). Currently, no methods are available for objectively quantifying joint attention. To train deep learning (DL) models to distinguish ASD from typical development (TD) and to differentiate ASD symptom severities using video data of joint attention behaviors. In this diagnostic study, joint attention tasks were administered to children with and without ASD, and video data were collected from multiple institutions from August 5, 2021, to July 18, 2022. Of 110 children, 95 (86.4%) completed study measures. Enrollment criteria were 24 to 72 months of age and ability to sit with no history of visual or auditory deficits. Children were screened using the Childhood Autism Rating Scale. Forty-five children were diagnosed with ASD. Three types of joint attention were assessed using a specific protocol. Correctly distinguishing ASD from TD and different levels of ASD symptom severity using the DL model area under the receiver operating characteristic curve (AUROC), accuracy, precision, and recall. The analytical population consisted of 45 children with ASD (mean [SD] age, 48.0 [13.4] months; 24 [53.3%] boys) vs 50 with TD (mean [SD] age, 47.9 [12.5] months; 27 [54.0%] boys). The DL ASD vs TD models showed good predictive performance for initiation of joint attention (IJA) (AUROC, 99.6% [95% CI, 99.4%-99.7%]; accuracy, 97.6% [95% CI, 97.1%-98.1%]; precision, 95.5% [95% CI, 94.4%-96.5%]; and recall, 99.2% [95% CI, 98.7%-99.6%]), low-level response to joint attention (RJA) (AUROC, 99.8% [95% CI, 99.6%-99.9%]; accuracy, 98.8% [95% CI, 98.4%-99.2%]; precision, 98.9% [95% CI, 98.3%-99.4%]; and recall, 99.1% [95% CI, 98.6%-99.5%]), and high-level RJA (AUROC, 99.5% [95% CI, 99.2%-99.8%]; accuracy, 98.4% [95% CI, 97.9%-98.9%]; precision, 98.8% [95% CI, 98.2%-99.4%]; and recall, 98.6% [95% CI, 97.9%-99.2%]). The DL-based ASD symptom severity models showed reasonable predictive performance for IJA (AUROC, 90.3% [95% CI, 88.8%-91.8%]; accuracy, 84.8% [95% CI, 82.3%-87.2%]; precision, 76.2% [95% CI, 72.9%-79.6%]; and recall, 84.8% [95% CI, 82.3%-87.2%]), low-level RJA (AUROC, 84.4% [95% CI, 82.0%-86.7%]; accuracy, 78.4% [95% CI, 75.0%-81.7%]; precision, 74.7% [95% CI, 70.4%-78.8%]; and recall, 78.4% [95% CI, 75.0%-81.7%]), and high-level RJA (AUROC, 84.2% [95% CI, 81.8%-86.6%]; accuracy, 81.0% [95% CI, 77.3%-84.4%]; precision, 68.6% [95% CI, 63.8%-73.6%]; and recall, 81.0% [95% CI, 77.3%-84.4%]). In this diagnostic study, DL models for identifying ASD and differentiating levels of ASD symptom severity were developed and the premises for DL-based predictions were visualized. The findings suggest that this method may allow digital measurement of joint attention; however, follow-up studies are necessary for further validation.

Association between reactogenicity and immunogenicity after BNT162b2 booster vaccination: a secondary analysis of a prospective cohort study

ObjectivesA weak correlation between symptom severity and antibody levels after primary immunization against COVID-19 has already been shown. This study aimed to describe the association between reactogenicity and immunogenicity after booster vaccination. MethodsThis secondary analysis of a prospective cohort study included 484 healthcare workers who received a booster vaccination with BNT162b2. Anti-receptor binding domain (RBD) antibodies were assessed at baseline and 28 days after booster vaccination. Side effects were graded (none, mild, moderate, or severe) and reported daily for 7 days after booster vaccination. Spearman correlation coefficient (rho) was used to determine the correlations between the severity of each symptom and anti-RBD levels before vaccination and 28 days after. The Bonferroni method was used to adjust p values for multiple comparisons. ResultsMost of the 484 participants reported at least one local (451 [93.2%]) or systemic (437 [90.3%]) post-booster symptom. No correlations between the severity of local symptoms and antibody levels were found. Except for nausea, systemic symptoms showed weak but statistically significant correlations with 28-day anti-RBD levels (fatigue [rho = 0.23, p < 0.01], fever [rho = 22, p < 0.01], headache [rho = 0.15, p 0.03], arthralgia [rho = 0.2, p < 0.01], myalgia [rho = 0.17, p < 0.01]). There was no association between post-booster symptoms and pre-booster antibody levels. DiscussionThis study showed only a weak correlation between the severity of systemic post-booster symptoms and anti-SARS-CoV-2 antibody levels at 28 days. Therefore, self-reported symptom severity cannot be used to predict immunogenicity after booster vaccination.

Evaluating Effect Moderators in Cognitive Versus Behavioral Based CBT-Modules and Sequences Towards Preventing Adolescent Depression

ABSTRACT Objective The aim of this study was to investigate age group, gender, and baseline depressive symptom severity as possible effect moderators in (1) cognitive versus behavioral based CBT-modules and (2) sequences of modules that started either with cognitive or behavioral modules in indicated depression prevention in adolescents. Method We conducted a pragmatic cluster-randomized trial under four parallel conditions. Each condition consisted of four CBT-modules of three sessions (cognitive restructuring, problem solving, behavioral activation, relaxation), but the sequencing of modules differed. The CBT-modules and sequences were clustered into more cognitive versus more behavioral based approaches. The sample involved 282 Dutch adolescents with elevated depressive symptoms (Mage = 13.8; 55.7% girls, 92.9% Dutch). Assessments were conducted at baseline, after three sessions, at post-intervention and 6-month follow-up with self-reported depressive symptoms as the primary outcome. Results We found no evidence for substantial moderation effects. Age group, gender, and depressive symptom severity level at baseline did not moderate the effects of cognitive versus behavioral modules after three sessions. No evidence was also found that these characteristics moderated the effectiveness of sequences of modules that started either with cognitive or behavioral modules at post-intervention and 6-month follow-up. Conclusion Cognitive and behavioral based modules and sequences in the prevention of depression in adolescents might apply to a relatively wide range of adolescents in terms of age group, gender, and severity levels of depressive symptoms. Abbreviation: CDI-2:F: Children’s Depression Inventory-2 Full-length version; CDI-2:S: Children’s Depression Inventory-2 Short version; STARr: Solve, Think, Act, Relax, and repeat

Development and validation of the Schedule for the Assessment of Insight in Alcohol Dependence (SAI-AD): Dimensions and correlates of insight in alcohol use disorder

IntroductionThe objectives of this study were to develop a multidimensional, clinician-rated scale that assess impaired insight into illness in patients with alcohol use disorder (AUD) and to examine its reliability, validity and internal structure. Moreover, we investigated the relationships of overall insight and its dimensions with demographic and clinical characteristics in AUD. MethodsWe developed the Schedule for the Assessment of Insight in Alcohol Dependence (SAI-AD), based on scales that has already been used in psychosis and other mental disorders. Sixty-four patients with AUD were assessed with SAI-AD. Hierarchical cluster analysis and multidimensional scaling were used to identify insight components and assess their inter-relationships. ResultsThe SAI-AD demonstrated good convergent validity (r = −0.73, p < 0.001) and internal consistency (Cronbach’s alpha = 0.72). Inter-rater and test-retest reliabilities were high (intra-class correlations 0.90 and 0.88, respectively). Three subscales of SAI-AD were identified which measure major insight components: awareness of illness, recognition of symptoms and need for treatment, and treatment engagement. Higher levels of depression, anxiety and AUD symptom severity were associated with overall insight impairment but not with recognition of symptoms and need for treatment, or with treatment engagement. Illness duration was specifically and positively associated with the treatment engagement component of insight. ConclusionsInsight is a multidimensional construct in AUD and its major components appear to be associated with different clinical aspects of the disorder. The SAI-AD is a valid and reliable tool for the assessment of insight in AUD patients.

The Role of Family Support and Dyadic Adjustment on the Psychological Well-being of Transgender Individuals: An Exploratory Study

IntroductionThis study aimed to measure dyadic adjustment, social support, and psychological well-being.MethodsA research protocol composed of the Dyadic Adjustment Scale, the Outcome Questionnaire 45.2, and the Multidimensional Scale of Perceived Social Support was administered to a sample of 109 Italian transgender individuals.ResultsHigher levels of global psychological distress, symptom severity, and interpersonal relationship distress were associated with lower levels of family support and dyadic adjustment. In addition, transgender women and younger transgender individuals reported higher levels of interpersonal relationship distress.ConclusionsThe results indicate that the support and acceptance of one’s partner and family of origin play a crucial role in promoting well-being. It represents an important protective factor with respect to negative psychological health outcomes.Policy ImplicationsThe findings emphasize the need to develop specific clinical and social practices for transgender individuals and their families. Building family and partner-centered policies and programs is particularly important to enable transgender individuals to avoid paying the emotional and psychological costs associated with rejection and non-acceptance.

Determinants of post-COVID-19 symptoms among adults aged 55 or above with chronic conditions in primary care: data from a prospective cohort in Hong Kong.

Primary care patients, especially those with an older age, are one of the most vulnerable populations for post-COVID-19 symptoms. Identifying predictors of post-COVID symptoms can help identify high-risk individuals for preventive care. Out of 977 primary care patients aged 55 years or above with comorbid physical and psychosocial conditions in a prospective cohort in Hong Kong, 207 patients infected in the previous 5-24 weeks were included. The three most common post-COVID-19 symptoms (breathlessness, fatigue, cognitive difficulty), which lasted beyond the 4-week acute infection period, were assessed using items from the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), together with other self-reported symptoms. Multivariable analyses were conducted to identify predictors of post-acute and long COVID-19 symptoms (5-24 weeks after infection). The 207 participants had a mean age of 70.8 ± 5.7 years, 76.3% were female, and 78.7% had ≥2 chronic conditions. In total, 81.2% reported at least one post-COVID symptom (mean: 1.9 ± 1.3); 60.9, 56.5 and 30.0% reported fatigue, cognitive difficulty, and breathlessness respectively; 46.1% reported at least one other new symptom (such as other respiratory-related symptoms (14.0%), insomnia or poor sleep quality (14.0%), and ear/nose/throat symptoms (e.g., sore throat) (10.1%), etc.). Depression predicted post-COVID-19 fatigue. The female sex predicted cognitive difficulty. Receiving fewer vaccine doses (2 doses vs. 3 doses) was associated with breathlessness. Anxiety predicted a higher overall symptom severity level of the three common symptoms. Depression, the female sex, and fewer vaccine doses predicted post-COVID symptoms. Promoting vaccination and providing intervention to those at high-risk for post-COVID symptoms are warranted.

Depression symptoms, anxiety, and stress among undergraduate entrance admission seeking students in Bangladesh: a cross-sectional study.

Intense academic pressure and unhealthy competition have turned the university entrance exam scenario in Bangladesh into a Pandora's Box, which might cause mental health difficulties among young students. However, there is a severe scarcity of studies concerning such issues of university entrance examination-seeking students in Bangladesh. This study aimed to assess the prevalence and associated factors of depression symptoms, anxiety, and stress among undergraduate entrance admission-seeking students in Bangladesh. A cross-sectional study design was followed using an online tool including socio-demographic questions, and the 21-item Bangla Depression, Anxiety and Stress Scale (BDASS-21). The survey form was completed by 452 Bangladeshi students who passed the higher secondary certificate (HSC) examination in 2020 and were planning to get admission to the undergraduate level during the data collection. The prevalence of mild to extremely severe levels of depression symptoms, anxiety, and stress was 57.7%, 61.4%, and 44.6%, respectively. Females were more likely to have depression, anxiety, and stress symptoms than males. The students from science backgrounds were at higher risk of developing depression and stress symptoms when compared with students from business studies backgrounds. Besides, students with a previous history of mental illness, a preference for getting admitted into the public university, and less monthly family income (<25,000 BDT) were more likely to develop depression, anxiety, and stress symptoms. In addition, students with a previous history of neurological disorders were more likely to develop anxiety symptoms than those without. This study revealed a high level of depression, anxiety, and stress symptoms among undergraduate entrance admission-seeking students, which calls for in-depth exploratory investigations. Adequate low-intensity interventions should be designed to support this young population.

The mediating role of coping self-efficacy on social support and PTSD symptom severity among injury survivors

ABSTRACT Background Social support confers a protective effect against elevated PTSD symptomatology following injury. However, little is known about the mechanisms through which social support conveys this protective mental health effect in injury survivors. Coping self-efficacy is linked to both social support and PTSD symptomatology but has not been examined. Objective To test coping self-efficacy as a mechanism for the relationship between social support and PTSD symptom severity among injury survivors. Method and Design Participants consisted of 61 injury survivors (62.3% male, 72.1% White) admitted to a Level-1 Trauma Center. Social support was assessed at 2-weeks post-injury; coping self-efficacy at 6-weeks post-injury; and PTSD symptom severity at 3-months post-injury. Results A statistically significant indirect effect was found for the social support – coping self-efficacy – PTSD symptomatology pathway, providing evidence of mediation even after controlling for age, sex, race, and education (B = −0.51, SE = 0.18, CI = −0.92, −0.20). Conclusions Social support may exert an effect on PTSD symptom severity post-injury through its connection with coping self-efficacy. Coping self-efficacy represents an important intervention target following injury for those survivors with lower social support who are at risk for elevated PTSD symptom severity levels.

Data-driven Approach to Identify Subtypes and Progression of Parkinson’s disease using Multimodal Imaging Data (P6-11.006)

<h3>Objective:</h3> To identify neuroanatomical subtypes of patients with Parkinson’s disease (PD) and to define how they differ in motor symptoms. To investigate how the neuroanatomy and motor symptoms of these subtypes change over time. <h3>Background:</h3> Novel approaches to parse the heterogeneity in PD based on neurobiological mechanisms are needed to improve the efforts in precision medicine. Here, we used multimodal imaging data to identify PD subtypes and their progression. <h3>Design/Methods:</h3> T1-weighted, diffusion tensor imaging data and clinical motor scores were obtained from the Parkinson’s Progression Markers Initiative database (www.ppmi-info.org/data) for 61 PD patients at both baseline and 48-month follow-up, and 70 healthy controls (HC) at baseline only. We extracted mean cortical thickness (CTh, reflecting cortical morphometry) from 68 cortical regions, and mean quantitative anisotropy (QA, reflecting the axonal integrity) from 45 white matter tracts. Using Mahalanobis distance, multivariate summary scores of CTh (M_CTh) and QA (M_QA) were derived and selected as features for heterogeneity through discriminative analysis. Group differences in neuroanatomical variables (M_CTh, M_QA), and motor symptoms between HC and PD subtypes were tested using ANOVA. To assess the longitudinal changes, a linear mixed-effect model was used. <h3>Results:</h3> Three PD subtypes were identified. Subtype 1 showed no detectable neuroanatomical abnormalities and mild motor symptoms at baseline. However, over time, these patients demonstrated substantial axonal degeneration with worsened motor symptoms. Subtype 2 showed cortical atrophy and severe motor symptoms at baseline, but with significant axonal degeneration and absence of changes in motor symptoms over time. Subtype 3 characterized by axonal damage and severe motor symptoms at baseline, displays no neuroanatomical or motor symptom deterioration over time. <h3>Conclusions:</h3> We parsed the heterogeneity of PD using CTh and QA data and identified three distinct PD subtypes with different severity levels of motor symptoms and different patterns of neuroanatomical and symptom progression. <b>Disclosure:</b> Dr. Ambili Vijayakumari has nothing to disclose. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerevel. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Fernandez has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Fernandez has received research support from Biogen. The institution of Dr. Fernandez has received research support from Michael J Fox Founda. The institution of Dr. Fernandez has received research support from Roche. The institution of Dr. Fernandez has received research support from Parkinson Foundation. The institution of Dr. Fernandez has received research support from UCB. Dr. Fernandez has received publishing royalties from a publication relating to health care. Dr. Fernandez has received personal compensation in the range of $10,000-$49,999 for serving as a Steering Committee/Advisory Committee Member with Parkinson Study Group. Dr. Walter has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Acorda. Dr. Walter has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Lundbeck. Dr. Walter has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medtronic. Dr. Walter has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teva. Dr. Walter has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbott.

Genetic and environmental contributions to co-occurring physical health conditions in autism spectrum condition and attention-deficit/hyperactivity disorder

BackgroundAutism spectrum condition and attention-deficit/hyperactivity disorder (ADHD) are associated with a range of physical health conditions. The aim of this study was to examine the etiological components contributing to co-occurring physical health conditions in autism and ADHD.MethodsIn this nationwide Child and Adolescent Twin Study in Sweden, we analyzed data from 10,347 twin pairs aged 9 and 12. Clinical diagnoses of autism, ADHD, and physical health conditions were identified through the Swedish National Patient Register. Subclinical phenotypes of autism and ADHD were defined by symptom thresholds on a standardized parent-interview, the Autism–Tics, ADHD, and Other Comorbidities inventory. Associations between physical health conditions and autism/ADHD phenotypes were examined using generalized estimating equations. Bivariate twin models were applied to estimate the extent to which genetic and environmental risk factors accounted for physical health comorbidities.ResultsSimilar patterns of association with physical health conditions were found in clinical and subclinical autism/ADHD, with odds ratios ranging from 1.31 for asthma in subclinical ADHD to 8.03 for epilepsy in clinical autism. The estimated genetic correlation (ra) with epilepsy was 0.50 for clinical autism and 0.35 for subclinical autism. In addition, a modest genetic correlation was estimated between clinical autism and constipation (ra = 0.31), functional diarrhea (ra = 0.27) as well as mixed gastrointestinal disorders (ra = 0.30). Genetic effects contributed 0.86 for mixed gastrointestinal disorders in clinical ADHD (ra = 0.21). Finally, subclinical ADHD shared genetic risk factors with epilepsy, constipation, and mixed gastrointestinal disorders (ra = 0.30, 0.17, and 0.17, respectively).LimitationsImportantly, since medical records from primary care were not included in the registry data used, we probably identified only more severe rather than the full range of physical health conditions. Furthermore, it needs to be considered that the higher prevalence of physical health conditions among autistic children and children with ADHD could be associated with the increased number of medical visits.ConclusionsShared genetic effects contribute significantly to autism and ADHD phenotypes with the co-occurring physical health conditions across different organ systems, including epilepsy and gastrointestinal disorders. The shared genetic liability with co-occurring physical health conditions was present across different levels of autism and ADHD symptom severity.

Beech Leaf Disease Severity Affects Ectomycorrhizal Colonization and Fungal Taxa Composition.

Beech leaf disease (BLD) is an emerging forest infestation affecting beech trees (Fagus spp.) in the midwestern and northeastern United States and southeastern Canada. BLD is attributed to the newly recognized nematode Litylenchus crenatae subsp. mccannii. First described in Lake County, Ohio, BLD leads to the disfigurement of leaves, canopy loss, and eventual tree mortality. Canopy loss limits photosynthetic capacity, likely impacting tree allocation to belowground carbon storage. Ectomycorrhizal fungi are root symbionts, which rely on the photosynthesis of autotrophs for nutrition and growth. Because BLD limits tree photosynthetic capacity, ECM fungi may receive less carbohydrates when associating with severely affected trees compared with trees without BLD symptoms. We sampled root fragments from cultivated F. grandifolia sourced from two provenances (Michigan and Maine) at two timepoints (fall 2020 and spring 2021) to test whether BLD symptom severity alters colonization by ectomycorrhizal fungi and fungal community composition. The studied trees are part of a long-term beech bark disease resistance plantation at the Holden Arboretum. We sampled from replicates across three levels of BLD symptom severity and compared fungal colonization via visual scoring of ectomycorrhizal root tip abundance. Effects of BLD on fungal communities were determined through high-throughput sequencing. We found that ectomycorrhizal root tip abundance was significantly reduced on the roots of individuals of the poor canopy condition resulting from BLD, but only in the fall 2020 collection. We found significantly more ectomycorrhizal root tips from root fragments collected in fall 2020 than in spring 2021, suggesting a seasonal effect. Community composition of ectomycorrhizal fungi was not impacted by tree condition but did vary between provenances. We found significant species level responses of ectomycorrhizal fungi between levels of both provenance and tree condition. Of the taxa analyzed, two zOTUs had significantly lower abundance in high-symptomatology trees compared with low-symptomatology trees. These results provide the first indication of a belowground effect of BLD on ectomycorrhizal fungi and contribute further evidence to the role of these root symbionts in studies of tree disease and forest pathology.

Time-Dependent Changes in Depressive Symptoms Among Control Participants in Digital-Based Psychological Intervention Studies: Meta-analysis of Randomized Controlled Trials

Digital-based psychological interventions (DPIs) have been shown to be efficacious in many randomized controlled trials (RCTs) in dealing with depression in adults. However, the effects of control comparators in these DPI studies have been largely overlooked, and they may vary in their effects on depression management. This meta-analytical study aimed to provide a quantitative estimate of the within-subject effects of control groups across different time intervals and explore the moderating effects of control types and symptom severity at baseline. A systematic literature search was conducted in late September 2021 on selected electronic databases: PubMed; ProQuest; Web of Science; and the Ovid system with MEDLINE, PsycINFO, and Embase. The control conditions in 107 RCTs with a total of 11,803 adults with depressive symptoms were included in the meta-analysis, and effect sizes (Hedges g) were calculated using the standardized mean difference approach. Study quality was assessed using the Cochrane risk-of-bias tool for randomized trials version 2. The control conditions collectively yielded small to moderate effects in reducing depressive symptoms within 8 weeks since the baseline assessment (g=-0.358, 95% CI -0.434 to -0.281). The effects grew to moderate within 9 to 24 weeks (g=-0.549, 95% CI -0.638 to -0.460) and peaked at g=-0.810 (95% CI -0.950 to -0.670) between 25 and 48 weeks. The effects were maintained at moderate to large ranges (g=-0.769, 95% CI -1.041 to -0.498) beyond 48 weeks. The magnitude of the reduction differed across the types of control and severity of symptoms. Care as usual was the most powerful condition of all and produced a large effect (g=-0.950, 95% CI -1.161 to -0.739) in the medium term. The findings showed that waitlist controls also produced a significant symptomatic reduction in the short term (g=-0.291, 95% CI -0.478 to -0.104), refuting the previous suspicion of a nocebo effect. In addition, a large effect on depressive symptom reduction in the long term (g=-1.091, 95% CI -1.210 to -0.972) was noted among participants with severe levels of depressive symptoms at baseline. This study provided evidence that depressive symptoms generally reduced over time among control conditions in research trials of DPIs. Given that different control conditions produce variable and significant levels of symptomatic reduction, future intervention trials must adopt an RCT design and should consider the contents of control treatments when investigating the efficacy of DPIs. The results of waitlist controls confirmed previous findings of spontaneous recovery among people with mild to moderate depressive symptoms in face-to-face studies. Researchers may adopt watchful waiting as participants wait for the availability of digital-based psychological services.

The whole-body motor skills of children with autism spectrum disorder taking goal-directed actions in virtual reality.

Many symptoms of the autism spectrum disorder (ASD) are evident in early infancy, but ASD is usually diagnosed much later by procedures lacking objective measurements. It is necessary to anticipate the identification of ASD by improving the objectivity of the procedure and the use of ecological settings. In this context, atypical motor skills are reaching consensus as a promising ASD biomarker, regardless of the level of symptom severity. This study aimed to assess differences in the whole-body motor skills between 20 children with ASD and 20 children with typical development during the execution of three tasks resembling regular activities presented in virtual reality. The virtual tasks asked to perform precise and goal-directed actions with different limbs vary in their degree of freedom of movement. Parametric and non-parametric statistical methods were applied to analyze differences in children's motor skills. The findings endorsed the hypothesis that when particular goal-directed movements are required, the type of action could modulate the presence of motor abnormalities in ASD. In particular, the ASD motor abnormalities emerged in the task requiring to take with the upper limbs goal-directed actions with low degree of freedom. The motor abnormalities covered (1) the body part mainly involved in the action, and (2) further body parts not directly involved in the movement. Findings were discussed against the background of atypical prospective control of movements and visuomotor discoordination in ASD. These findings contribute to advance the understanding of motor skills in ASD while deepening ecological and objective assessment procedures based on VR.

Vulnerability to Mental Health Problems in Indian Population during Lockdown amidst COVID-19 Pandemic: An Alarm not to Snooze

Background: Lockdown measures are being implemented in several parts of the world to control the spread of novel coronavirus. This unprecedented crisis has significantly affected the lives of people in different ways. Aim: To understand the experiences and vulnerability to mental health problems during lockdown among the Indian population during COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted using an online survey form circulated through various social media platforms from April 12 to May 3, 2020 containing self-reported questionnaires to collect lockdown related experiences and scales to assess anxiety (GAD-7) and depression (PHQ-9). A convenience sampling method was used. Results: 442 valid responses were received from different states of India. Statistical analysis revealed that one-third of the respondents suffered from some form of anxiety and depression during a lockdown. Less than 10% of them had severe levels of symptoms. The majority were males aged 18-45 years and private sector employees. Delivering essential services was involved with significant anxiety and depression. Availability of food and daily essentials was the most common problem. Difficulty in availing medicines and financial crisis were significant predictors of anxiety and depression. Worsening of interpersonal relationships was associated with higher levels of anxiety and depression. Conclusions: The study concluded that experiences during the lockdown and associated psychological outcomes are important factors to consider and appropriate preventive measures to be taken in case of any future lockdowns.